Vestibular schwannoma microneurosurgery in patients over 70: a single institution experience and proposal of a treatment algorithm.
Age
Elderly
Facial nerve
Facial nerve position
Retrosigmoid approach
Vestibular schwannoma
Journal
Neurosurgical review
ISSN: 1437-2320
Titre abrégé: Neurosurg Rev
Pays: Germany
ID NLM: 7908181
Informations de publication
Date de publication:
08 Aug 2024
08 Aug 2024
Historique:
received:
03
03
2024
accepted:
25
07
2024
revised:
25
07
2024
medline:
9
8
2024
pubmed:
9
8
2024
entrez:
8
8
2024
Statut:
epublish
Résumé
Elderly patients with vestibular schwannoma (VS) are commonly observed. Retrospective analysis of 25 patients aging ≥ 70 operated on in our neurosurgical department for unilateral VS. The purpose of our study is to propose an algorithm for the treatment of VS in elderly patients. American Society of Anesthesiology (ASA) Grade I-II patients and Grade III with life-threatening tumors were enrolled. Karnofsky Performance Status Scale (KPS) was used for evalutation of the quality of life. The House-Brackmann (HB) scale for facial nerve (FN) outcome was used. Tumor size was categorized according to Koos' classification. A retrosigmoid approach was used in all cases, except one in which a translabyrinthine approach was performed. Surgical removal graduation: total (GTR), near total (NTR > 95%), subtotal (STR > 90%). The clinical and radiological follow-up period was set first at six months and then at one year after surgery. FN results evaluation was performed at one year, categorized according to House-Brackmann grades I-VI. Mean age: 74,4 years (70-83); 28% ASA I, 56% ASA II, 16% ASA III. Mean tumor size: 2,7 cm (1,5-4,2 cm). 68%, STR 32%. Mortality was zero. At last follow-up (one year after surgery) FN results were: HBI 81%, HBII 9.5%, HBIII 9.5%; HB IV 0%. Only 4 patients had preoperative HB IV, of whom one improved from HB IV to HB III. Transient complications occurred only in large VS. Re-growth of residue after STR was observed in 3 cases, treated with SRS in 2 cases and observed in 1. An algorithm of treatment of vestibular schwannoma in the elderly is proposed. In particular, in patients in general good conditions, age does not appear to be a major contraindication for microsurgery of VS. FN results at last follow-up are satisfactory and the complication rates are acceptable.
Sections du résumé
BACKGROUND
BACKGROUND
Elderly patients with vestibular schwannoma (VS) are commonly observed.
OBJECT
OBJECTIVE
Retrospective analysis of 25 patients aging ≥ 70 operated on in our neurosurgical department for unilateral VS. The purpose of our study is to propose an algorithm for the treatment of VS in elderly patients.
METHODS
METHODS
American Society of Anesthesiology (ASA) Grade I-II patients and Grade III with life-threatening tumors were enrolled. Karnofsky Performance Status Scale (KPS) was used for evalutation of the quality of life. The House-Brackmann (HB) scale for facial nerve (FN) outcome was used. Tumor size was categorized according to Koos' classification. A retrosigmoid approach was used in all cases, except one in which a translabyrinthine approach was performed. Surgical removal graduation: total (GTR), near total (NTR > 95%), subtotal (STR > 90%). The clinical and radiological follow-up period was set first at six months and then at one year after surgery. FN results evaluation was performed at one year, categorized according to House-Brackmann grades I-VI.
RESULTS
RESULTS
Mean age: 74,4 years (70-83); 28% ASA I, 56% ASA II, 16% ASA III. Mean tumor size: 2,7 cm (1,5-4,2 cm).
GTR/NTR
UNASSIGNED
68%, STR 32%. Mortality was zero. At last follow-up (one year after surgery) FN results were: HBI 81%, HBII 9.5%, HBIII 9.5%; HB IV 0%. Only 4 patients had preoperative HB IV, of whom one improved from HB IV to HB III. Transient complications occurred only in large VS. Re-growth of residue after STR was observed in 3 cases, treated with SRS in 2 cases and observed in 1.
CONCLUSIONS
CONCLUSIONS
An algorithm of treatment of vestibular schwannoma in the elderly is proposed. In particular, in patients in general good conditions, age does not appear to be a major contraindication for microsurgery of VS. FN results at last follow-up are satisfactory and the complication rates are acceptable.
Identifiants
pubmed: 39117744
doi: 10.1007/s10143-024-02615-6
pii: 10.1007/s10143-024-02615-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
410Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Matthies C, Samii M, Krebs S (1997) Management of vestibular schwannomas (acoustic neuromas): radiological features in 202 cases — their value for diagnosis and their predictive importance. Neurosurgery 40:248–260
pubmed: 9007856
Dang L, Tu NC, Chan EY (2020) Current imaging tools for vestibular schwannoma. Curr Opin Otolaryngol Head Neck Surg 28:302–307
doi: 10.1097/MOO.0000000000000647
pubmed: 32833884
Di Ieva A, Lee JM, Cusimano MD (2016) Handbook of skull base surgery. Thieme, New York, pp 163–1006. https://doi.org/10.1055/b-0036-131002
Winn HR (2017) Youmans and Winn neurological surgery, 7th edn, ed. Philadelphia, PA, Elsevier, pp 1215–1216
Park JK, Vernick DM, Ramakrishna N (2018) Vestibular schwannoma (acoustic neuroma). In: Post TW (ed) UpToDate. Waltham. https://pro.uptodatefree.ir/Show/5222
Quiñones-Hinojosa A, Rincon-Torroella J (2017) Video atlas of neurosurgery: contemporary tumor and skull base surgery, 1st edn, ed. Elsevier, Edinburgh, New York, p 285. https://www.clinicalkey.com/#!/browse/book/3-s2.0-C20130000588
Wu H, Zhang L, Han D et al (2016) Summary and consensus in 7th International Conference on acoustic neuroma: An update for the management of sporadic acoustic neuromas. World J Otorhinolaryngol Head Neck Surg 2:234–9
doi: 10.1016/j.wjorl.2016.10.002
pubmed: 29204572
pmcid: 5698531
Samii M, Matthies C (1997) Management of 1000 vestibular schwannomas (acoustic neuromas): the facial nerve–preservation and restitution of function. Neurosurgery 40:684–694
doi: 10.1097/00006123-199704000-00006
pubmed: 9092841
Samii M, Matthies C (1997) Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 40:11–21
pubmed: 8971819
Gal TJ, Shinn J, Huang B (2010) Current epidemiology and management trends in acoustic neuroma. Otolaryngol Head Neck Surg 142:677–681
doi: 10.1016/j.otohns.2010.01.037
pubmed: 20416455
Reznitsky M, Petersen M, West N et al (2019) Epidemiology Of Vestibular Schwannomas - Prospective 40-Year Data From An Unselected National Cohort. Clin Epidemiol 11:981–986
doi: 10.2147/CLEP.S218670
pubmed: 31807080
pmcid: 6850685
Schneider AJL (1983) Assessment of risk factor and surgical outcome. Surg Clin North Am 63:1113–1126
doi: 10.1016/S0039-6109(16)43141-5
pubmed: 6356419
Kanzaki J, Tos M, Sanna M, aI, (2003) New and modified reporting systems from the consensus meeting on systems for reporting results in vestibular schwannoma. Otol Neurotol 24:642–648
doi: 10.1097/00129492-200307000-00019
pubmed: 12851559
Koos WT, Day JD, Matula C, Levy DI (1998) Neurotopographic considerations in the microsurgical treatment of small acoustic neurinomas. J Neurosurg 88:506–512
doi: 10.3171/jns.1998.88.3.0506
pubmed: 9488305
Mastronardi L, Cacciotti G, Roperto R et al (2016) Position and course of facial nerve and postoperative facial nerve results in vestibular schwannoma microsurgery. World Neurosurg 94:174–180
doi: 10.1016/j.wneu.2016.06.107
pubmed: 27389936
Sameshima T, Morita A, Tanikawa R et al (2013) Evaluation of variation in the course of the facial nerve, nerve adhesion to tumors, and postoperative facial palsy in acoustic neuroma. J Neurol Surg B Skull Base 74:39–43
pubmed: 24436886
Committee on Hearing and Equilibrium (1995) Committee on hearing and equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma). American academy of otolaryngology-head and neck surgery foundation, INC. Otolaryngol Head Neck Surg 113:179–180. https://doi.org/10.1016/S0194-5998(95)70101-X
House JW, Brackmann DE (1985) Facial nerve grading system. Otolaryngol Head Neck Surg 93:146–147
doi: 10.1177/019459988509300202
pubmed: 3921901
Van Abel KM, Carson ML, Driscoll CL et al (2014) Vestibular schwannoma surgery in the elderly: a matched cohort study. J Neurosurg 120:207–217
doi: 10.3171/2013.6.JNS122433
pubmed: 23870020
Nuseir A, Sequino G, De Donato G et al (2012) Surgical management of vestibular schwannoma in elderly patients. Eur Arch Otorhinolaryngol 269:17–23
doi: 10.1007/s00405-011-1566-2
pubmed: 21431956
Perry B, Gantz BJ, Rubinstein JT (2001) Acoustic Neuromas in the Elderly. Otology and Neurology 22:389–391
doi: 10.1097/00129492-200105000-00020
Roehm PC, Gantz B (2007) Management of Acoustic Neuromas in Patients 65 Years or Older. Otol Neurotol 28:708–714
doi: 10.1097/01.mao.0000281805.44197.ec
pubmed: 17667776
Pulec JL (1999) Acoustic neuroma surgery in geriatric patient. Ear Nose Throat J 78:429–430
doi: 10.1177/014556139907800612
pubmed: 10388194
Glasscock ME 3rd, Pappas DG Jr, Manolidis S et al (1997) Management of acoustic neuroma in the elderly population. Am J Otol 18:236–241
pubmed: 9093682
Pulec JL, Giannotta SL (1995) Acoustic neuroma surgery in patient over 65 years of age. Ear Nose Throat J 74:21–27
doi: 10.1177/014556139507400107
pubmed: 7867527
Samii M, Tatagiba M, Matthies C (1992) Acoustic neurinoma in the elderly: factors predictive of postoperative outcome. Neurosurgery 31:615–619
pubmed: 1407445
van Roijen L, Nijs HG, Avezaat CJ et al (1997) Cost and effects of microsurgery versus radiosurgery in treating acoustic neuroma. Acta Neurochir (Wien) 139:942–948
doi: 10.1007/BF01411303
pubmed: 9401654
Shirato H, Sakamoto T, Sawamura Y et al (1999) Comparison between observation policy and fractionated stereotactic radiotherapy (SRT) as an initial management for vestibular schwannoma. Int J Radiat Oncol Biol Phys 44:545–550
doi: 10.1016/S0360-3016(99)00079-6
pubmed: 10348283
Sylvester MJ, Shastri DN, Viral MP, et al. (2016) Outcomes of Vestibular Schwannoma Surgery among the Elderly: Analysis of the National Inpatient Sample. Otolaryngology-Head and Neck Surgery 1-7 https://doi.org/10.1177/0194599816677522
Jahn K (2019) The Aging Vestibular System: Dizziness and Imbalance in the Elderly. Adv Otorhinolaryngol 82:143–149
pubmed: 30947233
Martins ESDC, Bastos VH, de Oliveira SM et al (2016) Effects of vestibular rehabilitation in the elderly: a systematic review. Aging Clin Exp Res 28:599–606
doi: 10.1007/s40520-015-0479-0
Deems DA, Deems RO, O’Malley BW Jr (2019) Managing Challenges in an Aging Vestibular System: Rehabilitation Strategies Normalize Balance Function in a Cohort of Patients Up to 99 Years. Ear Nose Throat J 98:37–43
doi: 10.1177/0145561318824541
pubmed: 30834792
Hruba S, Chovanec M, Cada Z et al (2019) The evaluation of vestibular compensation by vestibular rehabilitation and prehabilitation in short-term postsurgical period in patients following surgical treatment of vestibular schwannoma. Eur Arch Otorhinolaryngol 276:2681–2689
doi: 10.1007/s00405-019-05503-8
pubmed: 31187238
Tjernstrom F, Fransson PA, Kahlon B et al (2018) PREHAB vs. REHAB - presurgical treatment in vestibular schwannoma surgery enhances recovery of postural control better than postoperative rehabilitation: Retrospective case series. J Vestib Res 27:313–325
doi: 10.3233/VES-170626
pubmed: 29400686